E-ISSN 1305-3612
Breast Radiology - Original Article
Efficiency of the diagnostic pathway of BLES: could it be safely used as a therapeutic method in selected benign lesions?
1 Department of Radiology, Namık Kemal University School of Medicine, Tekirdağ, Turkey  
2 Department of General Surgery, Namık Kemal University School of Medicine, Tekirdağ, Turkey  
3 Department of Pathology, Namık Kemal University School of Medicine, Tekirdağ, Turkey  
4 Department of Biostatistics, Namık Kemal University School of Medicine, Tekirdağ, Turkey  
Diagn Interv Radiol ; : -

Abstract

 

PURPOSE: In this study, we aimed to show that the breast lesion excision system (BLES) can be a useful and practical alternative technique to surgical biopsy and other percutaneous biopsy methods for suspicious lesions in patients with malignant or high-risk lesions. We also wanted to share our initial experience with the BLES and compare it with standard percutaneous biopsy methods.

 

METHODS: From July 2015 to December 2016, a total 50 patients who had high-risk lesions which were diagnosed with core needle biopsy (CNB) or had lesions with radiology pathology discordance, or who were patients with high-risk factors, high grade anxiety, or suspicious follow-up lesions were enrolled in this study. These lesions were classified as Breast Imaging Reporting and Data System (BIRADS) 3 or 4 which are under 2 cm. Pathological diagnoses after the previous and BLES were evaluated comparatively. The diagnostic and therapeutic success CNB and the complications of the BLES were analyzed.

 

RESULTS: After BLES, two cases were diagnosed as atypical lobular hyperplasia (ALH) and atypical ductal hyperplasia (ADH). Since the surgical margin was negative, re-excision has not required. Two cases were diagnosed as malignant, and no residual tissue was detected in the operation region. Total excision rates were reported as 56%. Minor hematoma was observed in only 1 out of 50 (2%) cases, and spontaneous remission was observed. Two (4%) patients complained of pain during the procedure. The specimen thermal damage associated with the radiofrequency (RF) was classified according to the diameter in 4 categories: 88% in Grade 0 (< 0.5 mm), 10% in Grade 1 (0.5-1.5 mm), 2% in Grade 2 (> 1.5 mm or thermal damage in diffuse areas), and 0% in Grade 3 (diffuse thermal damage or inability to diagnose). We found a significant positive correlation between classification of thermal damage and lesion fat cell content (r = 0.345, P = 0.015).

 

CONCLUSION: BLES is a safe technique that can be effectively used with low complication rates in the excision of benign and high-risk breast lesions in selected cases. In our study, we evaluated the efficiency of the diagnostic pathway of BLES. It may also provide high diagnostic success and even serve as a therapeutic method in high-risk lesions, such as radial scar, papilloma, and ALH with high complete excision rates without fragmentation of lesions.

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